【論文摘要】REAL-CAD Study: Further Direction of LDL-C Lowering Treatment in Asians

Katsumi Miyauchi

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 17-17

https://doi.org/10.6907/SCJ.201909/SP_1(2).0015

摘要

Many clinical trials have shown the benefits of early and intensive statin therapy in ACS. A meta-analysis of trials comparing more- vs. less-intensive LDL-C lowering with statins showed that more-intensive statin therapy produced greater reductions in the risks of cardiovascular events. For every 1.0 mmol/L reduction in LDL-C, these further reductions in risk were similar to the proportional reductions in the trials of statins vs. control. Based on these clinical evidences, what is common among the guidelines of the Heart society in Europe, the US and Japan is that statins are 1st line therapy in patients with acute coronary syndrome. In Japan, many plaque regression trials were reported, in which the marked efficacy of high-dose statin treatment in bringing about plaque regression was observed. However, there is no large scare clinical trial to prove higher-dose statin would be beneficial comparing the low-dose statin in patients with stable CAD in Japan. REAL-CAD is large scare clinical trial with 13,000 CAD patients. As results, high-dose pitavastatin improves CV outcomes more than low-dose pitavastatin and is also associated with a total mortality reduction in Japanese patients. Furthermore, high-dose pitavastatin is well tolerated. REAL-CAD is a practice-changing trial, suggesting that the administration of maximum tolerable doses of statins, within the range of local approval, would be the preferred statin strategy in patients with established coronary artery disease. Several recent large scare clinical trials have also shown that lowering LDL with non-statins reduced cardiovascular events. In CAD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions of CV events in the IMPROVE IT, FOURIER, and most recently the ODYSSEY-OUTCOMES trials. In this session, I would like to discuss the future direction of LDL-C lowering treatment in Asians from the results of clinical trials in Asia or in Europe and the United States.